Photobiomodulation therapy on orthodontic movement: analysis of preliminary studies with a new protocol

This study aimed to investigate the effectiveness of photobiomodulation therapy (PBMT) on the acceleration of orthodontic movements, deriving from its biostimulating and regenerative capacity on soft tissues, consequent to the increase in differentiation, proliferation, and activity of cells that are involved with alveolar bone remodeling. The present randomized controlled trial was conducted on six patients who required extractive orthodontic therapy because their ectopic canines had erupted. A total of eight canines were analyzed, four of which received laser irradiation (i.e., experimental group). Two weeks after the extractions, all canines of the experimental and placebo groups were distalized simultaneously and symmetrically with the laceback retraction technique. The PBMT protocol consisted of four cycles of laser applications, one each on days 0, 3, 7, and 14 of the study, with session treatment durations of 2-4 min. The results of the descriptive analysis on the distal displacement speed of the canines after 1 month of follow-up indicate an average displacement of 1.35 mm for the non-irradiated group and 1.98 mm for the irradiated group. Through inferential analysis, a statistically significant difference (p < 0.05) was found between the average speed of the irradiated canines and the control canines. The low energy density laser used in this study, with the parameters set, was found to be a tool capable of statistically significantly accelerating the distal displacement of canines

CO2 and diode lasers vs. conventional surgery in the disinclusion of palatally impacted canines: a randomized controlled trial

Abstract: Background: The aim of this RCT is to show the effectiveness of laser technology for the exposure of palatally impacted canines, using a CO2 or diode laser, and to evaluate the possible bio-stimulation effect of the laser on the spontaneous eruption of the canine. Methods: This study was carried out on a sample of 27 patients, divided randomly into three groups: treated with a CO2 laser (Group A), treated with a diode laser (Group B), and treated with a cold blade (Group C). Monitoring was performed at 1, 8, and 16 weeks after surgery, through photo and digital scans performed with a CS3500 intraoral scanner. Results: It was found that the average total eruptions are 4.55 mm for Group A, 5.36 mm for Group B, and 3.01 mm for Group C. The difference in eruption between groups A and B is not significant. Comparing the laser groups with the control group, it has emerged that the difference in eruption is statistically significant. Conclusion: A significant tooth movement was observed in both Groups A and B. The response of the canine to the bio-stimulation of the laser can be considered effective, resulting in a statistically significant difference between the study groups and the control group. Both lasers have the same bio-stimulatory action on the eruption of canines

Efficacy and accuracy of maxillary arch expansion with clear aligner treatment

The aim of this work was to evaluate the efficacy and accuracy of maxillary arch transverse expansion using the Invisalign® clear aligner system without auxiliaries other than Invisalign attachments. Knowing the accuracy of a movement through a clear aligner system allows the clinician to plan the treatment with greater precision and to achieve the expected result faster. The study group included 28 patients with a mean age of 17 ± 3.2 years. The treatment protocol for all the selected patients included the application of the Invisalign® clear aligner system without auxiliaries, except for the Invisalign® attachments; in no case were tooth extraction or interproximal enamel reduction (IPR) performed. Linear measurements of the expansion were assessed before treatment (T0), at the end of treatment (T1), and on final virtual models by ClinCheck® (TC). A paired t-test was used to compare T0-T1 and T1-TC differences. A paired t-test was applied, and one normality was validated with the Shapiro-Wilks test. If normality was not met, the nonparametric test (Mann-Whitney U test) was applied. The level of significance was set at 5%. Statistically significant differences were found for all measurements at T0-T1. The results showed an average accuracy of efficacy of 70.88%. The differences in predictability between the various vestibular measurements (intercanine, inter-premolar, and intermolar) were not statistically significant, while they were for gingival measurements. The overall accuracy of the expansion treatment was 70%, regardless of tooth type

Is There a Correlation between Gingival Display and Incisal Inclination in a Gummy Smile? Study on Cephalometric Parameters

Background: Excessive gingival display or “gummy smile” is a clinical condition where a maxillary gum shows between the inferior line of the superior lip and the gingival line of the incisive superior during a spontaneous smile. The aim of this research was to understand the various skeletal and dentoalveolar components contributing to a gummy smile in a sample of 120 patients. Material and Methods: This retrospective case-control study had the primary objectives of analyzing the existence of a correlation between the presence of gingival exposure and the alteration of the inclination of the upper incisors with respect to the Frankfurt plane, the Palatine plane (bi-spinal) and to the NA line in a sample of orthodontic patients, and also evaluating the association with skeletal, dental, and aesthetic cephalometric parameters. Result and Conclusions: In our study, it’s emerged a correlation between the gingival exposure and the presence of alterations to incisal torque in the vestibular direction and the quantity of maxillary gingiva evident during the smile, which is correlated in particular to the Is–Sts distance, overjet and overbite. The major indicative data, therefore, are related to the vertical position of the upper incisors, in particular with respect to the upper lip and to the sagittal position

CO2 laser for surgical treatment of impacted canines

INTRODUCTION Impaction is defined as the failure of tooth eruption at its correct site in the dental arch, in its normal period of growth. The permanent maxillary canine is the most commonly impacted tooth after third molars, it has a predilection for the oral side with a tendency to be unilateral. It is more common in females. The etiology is unclear: orally impacted canines can be associated with hypoplastic or missing lateral incisors or with aplasia of premolars, presence of supernumerary teeth and malpositioned third molars. There are many possible surgical techniques to approach impacted canines: early interceptive intervention or late intervention, including extraction, autotransplantation, surgical exposure of the canine’s crown with open or closed technique and subsequent orthodontic alignment. The choice depends on canine position, associated malocclusion, skill and experience of orthodontist and surgeon, patient compliance. Literature reports that High-Intensity Laser Therapies (HILT) with cutting action on the soft tissues, can also be used for opercolectomy of impacted tooth. MATERIALS AND METHODS A 13-years-old male referred to the Department of Oral and Maxillo-Facial Sciences, “Sapienza” University of Rome, for an orthodontic examination because of the maxillary primary canines persistence in dental arch. Orthopanoramic x-ray showed osteomucosal impaction of both permanent maxillary canines. The family history revealed that patient’s mother had the same orthodontic problem. Cone Beam CT was requested to plan the surgical-orthodontic treatment. Surgical exposure of the impacted canines was performed using a CO2 laser (Smart US20D®, DEKA-Florence, Italy) and subsequent periodontal wrap application. No orthodontic devices were applied for impacted teeth traction on dental arch. Canines movement towards the dental arch was monitored at 1, 8 and 16 weeks post-surgery with intraoral scanner CS3500 (Carestream Dental). When canines crowns were completely erupted on palatal side, the alignment in the arch with direct/indirect bonding technique was performed. RESULTS Complete disimpaction of canines crown was obtained in only four months. CONCLUSIONS As mentioned in Literature, this case confirms that impacted canines exposure with CO2 laser has advantages if compared with traditional surgery: no bleeding during and after procedure, no need to use sutures and laser biostimulating effect allow spontaneous eruption faster than with conventional treatments

Disinclusion of Palatally Impacted Canines with Surgical and Photobiomodulating Action of a Diode Laser: Case Series

Background: The permanent maxillary canine is the most impacted tooth after third molars. There are many possible surgical techniques to approach impacted canines. The literature reports that high-intensity laser therapies (HILTs) can be used for opercolectomy of an impacted tooth. The aim of this study is to propose a new orthodontic-surgical approach using a laser for the disinclusion of palatally impacted canines. Methods: Nine patients presented maxillary primary canine persistence in the dental arch. Orthopanoramic X-ray and cone beam computed tomography (CBCT) showed the impaction of permanent maxillary canines. Surgical exposure was performed using a diode laser (Raffaello, DMT, Lissone, Italy, 980 nm + 645 nm). No orthodontic devices were applied for impacted tooth traction. Canine movement was monitored at 1, 8, 16 weeks post-surgery with photos and a CS3500 intraoral scanner (Carestream Dental, Atlanta USA) to evaluate their autonomous eruption. Results: No complications were observed. In all the cases, complete disimpaction of the treated canines was obtained in only four months. Conclusions: Impacted canine exposure with a diode laser has many advantages if compared with traditional surgery. The pre-orthodontic exposure and autonomous eruption of impacted canines provided simplified and predictable outcomes. The absence of traction and the reduced time for orthodontic treatment increased compliance during the orthodontic alignment

CBCT and Intra-Oral Scanner: The Advantages of 3D Technologies in Orthodontic Treatment

Background: The aim is to demonstrate the validity of the monitoring through intraoral scanner of the dental movements and the real impact, advantages, and convenience, in terms of treatment time and efficiency gain, to frequently monitor a patient with the scanner application. Methods: A movement control of palatally impacted canines was performed, surgically treated with laser opercolectomy. Three-dimensional models of the patient’s dental arch were obtained with intraoral scanner during a monitoring time of 4 months. The STL (Standard Triangle Language) files were superimposed with the 3D models extrapolated from the pre-operative CT (Computerized Tomography). The measurements of eruption, exposed palatal and vestibular areas, and distances between the canines and the incisors were performed, using digital technologies and with a digital caliber. Results: Descriptive and inferential statistical analysis of the data obtained from both conventional and digital monitoring has been realized and performing the T Student Test for paired data. Conclusion: The advantages of digital monitoring are numerous, like the possibility to reduce the error of method caused by manual measurement on plaster casts and the possibility to compare the pattern and amount of eruption of the canine in the same patient overtime